Clinical Characteristics, Risk Factors, and Development and Evaluation of a Prediction Model for Pressure Injury in Patients With Severe Neurological Diseases

Objective To investigate the clinical characteristics and influencing factors of pressure injury in patients with severe neurological diseases and to construct and evaluate a predictive model for it.

Methods A retrospective research method was adopted to collect 250 patients with severe neuropathy admitted to the First Affiliated Hospital of Wenzhou Medical University from April 2020 to April 2024, and their clinical characteristics were collected. The patients were then divided into a pressure injury group (n = 58) and a non-pressure injury group (n = 192) based on whether they development pressure injury after treatment. Baseline data on patient coma or lethargy status, primary diagnosis requiring neurocritical care admission, and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were collected. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves for acute cerebrovascular disease, coma or lethargy status, and APACHE Ⅱ scores of the subjects was compared.

Results Among the 250 patients with severe neurological diseases, 58 had pressure injuries. Of these, 35 (60.34%) had mucosal pressure injuries, while 23 (39.66%) had device-related pressure injuries. According to the National Pressure Injury Advisory Panel Pressure Injury Staging System, 46 cases (79.31%) had stage 1 pressure injuries, 8 cases(13.97%) had stage 2 pressure injuries, 4 cases (6.90%) had stage 3 pressure injuries, and no patients had stage 4 pressure injuries. Logistic multivariate regression analysis showed that primary diagnosis requiring neurocritical care admission (odds ratio OR = 3.102; 95% CI, 1.013-9.499), coma or lethargy status (OR =3.769; 95% CI, 1.237-11.478), and APACHE Ⅱ score (OR =0.201; 95% CI, 0.124-0.328) were influencing factors for pressure injury in patients with severe neurological diseases. The ROC results showed that the AUC of the prediction model combining the 3 influencing factors was 0.974 (95% CI, 0.957-0.992), and that the sensitivity and specificity were 91.40% and 93.70%, respectively. The prediction accuracy of the combination prediction model was 0.96, which was significantly higher than those of the prediction models based on the 3 separate influencing factors (P < 0.05). The Hosmer-Lemeshow test showed that the model had a good fit (χ² = 4.779, P = 0.062), indicating that the model had a relatively high accuracy.

Conclusion Acute cerebrovascular disease, coma or lethargy, and APACHE Ⅱ score have different predictive values for pressure injury in patients with severe neurological diseases. While acute cerebrovascular disease and coma or lethargy have the same predictive value separately, the combination prediction incorporating the 3 influencing factors demonstrated superior accuracy and holds considerable potential for clinical application.